The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limit innovation by accountable care organizations (“ACOs”) participating in the Medicare Shared Savings Program (“MSSP”) (see “Final Waivers in Connection with the Shared Savings Program Final Rule” (80 Fed. Reg. 66,743) (Oct. 29, 2015)) (the “Waiver Final Rule”)). Pursuant to the Waiver Final Rule, Integra Community Care Network, LLC (“Integra”) seeks protection for the arrangements described below under the Participation Waiver described in the Waiver Final Rule:
Integra and Care New England Health System (“CNE”), Integra’s parent entity, have adopted EHR Remote Access and Services Agreements (“EHR Agreements”) for physicians and medical groups participating in the MSSP that are, or have contractually committed to become, MSSP ACO Participants that meet certain eligibility criteria (collectively, “Medical Groups”). Under the EHR Agreements, CNE provides certain donated or discounted items and services to Medical Groups, including EHR services and support. In addition, Integra and CNE have entered into an agreement to provide funding support to Rhode Island Primary Care Physicians Corporation, an independent practice association, whose participating providers are MSSP ACO Participants, to fund EHR “super-user” and abstractionist positions to support the ongoing and continued maintenance, use, transmission, and receipt of EHR information among Integra’s MSSP ACO Participants, and to facilitate the provision of EHR support in a more efficient and effective manner (collectively, with the EHR Agreements, the “Arrangements”). The Arrangements, which were approved by the Board of Managers of Integra on July 30, 2019, support Integra’s multi-year plan to promote information sharing of patient records by addressing the implementation and ongoing support of EHR systems. The Arrangements are designed to: (a) advance the management and coordination of care for Medicare beneficiaries through the Integra MSSP ACO by, for example, enhancing the accuracy of patient health information, facilitating the ready exchange of patient health information among MSSP ACO Participants or outside providers and suppliers that have a role in coordinating and managing care for Medicare beneficiaries aligned with the Integra MSSP ACO, reducing the provision of duplicative testing, and enhancing safety by maintaining complete medication and allergy lists; and (b) encourage investment in infrastructure and redesigned care processes for high quality and efficient services delivery by allowing the Integra MSSP ACO to make maximum use of its care management infrastructure to achieve high-quality and efficient service delivery for all patients cared for by its contracted providers.